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Burnett county 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d ' o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 = <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and O <br /> � c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regg�qtionsof the State�off Wisconsin. <br /> / y o <br /> OWNER (Please Pr'nt) l Contractor or Surveyor or Agent o <br /> Ad ess Address ( - _ <br /> cc,/~zr lj I SQ'IM / <br /> City, Stade City, State,Zip Code <br /> Telepho _ Telephone <br /> /�' �� �� 40 e <br /> I r v/ <br /> Emergency/Fire No. and Road Name -�� 0 A4 f jl U FP yC(J � <br /> Legal Description (as indicated on tax statement) L/oo <br /> L <br /> Permit(s) Applied for: o` <br /> _ <br /> Dwelling Addition Filling/Grading Camping Unit o <br /> v <br /> Z o <br /> Accessory Building Sanitary Privy Subdivision o <br /> Garage /'� <br /> Structure Use: v �"r) <br /> r <br /> (family home/cabin, garage, addition, etc.) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: 0 <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). O <br /> 2. Show the location of the well (MI),septic tank (ST),and drainfield (DF). () 3 <br /> 3. Show the location of any lake or flowage- if within 1000 ft. and the location of any river or stream-if within P <br /> 300 ft. Z `v <br /> o a <br /> 4. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building n s �s <br /> to lake, river or stream, if applicable. M <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and C ( <br /> dated by the owner. N <br /> m <br /> PLOT PLAN r� (�'So t <br /> ar Le / <br /> IC- <br /> A, s <br /> Baa .dCn <br /> N j� <br /> r <br /> y f v L <br /> DF <br /> Z <br /> i <br /> 15M ecrct o,K, <br /> D ye" will ne2ct, <br /> C n yob ill trees— <br /> D N N N r D D O V <br /> P�o1c i brush n ° v D a m m <br /> 00 <br /> MF�6slca) q >< <br /> o F0 1 <br /> i m <br /> � s 4] ' ! p <br /> m [ [ S <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o N `� I <br /> m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor 8 <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g m 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this ap- y, <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have N <br /> access to the abov ascribed premis at any reasonable time for the purpose of inspection. m 8 <br /> m 3 A Z <br /> SIGN HERE � �` �- JO ` O H FnN gI <br /> (sig ature of owner or building contractor) (date) <br /> a <br /> o ? : <br /> ZONING ADMINISTRATOR g <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> N N O N <br /> tli tl, VI N O <br /> 888888 <br />